Canada direct deposit enrolment form

Protected "B" when completed.

This fillable form has been designed to make it easier for you to enrol in direct deposit. Please note that the completed form cannot be saved on your computer. Please print, sign and mail the enrolment form. You also have the option to print and complete the form by hand. For additional information or for assistance, you can:

• consult the Canada direct deposit enrolment form completion instructions;
• consult with your financial institution;
• call 1‑800‑593‑1666 toll free Monday, Tuesday, Wednesday and Saturday from 7 a.m. to 7 p.m. or Thursday and Friday from 7 a.m. to 10 p.m., Eastern Standard Time. People who use a telecommunication device for the deaf (TDD) / teletypewriter (TTY) should place calls with the assistance of Bell Relay Service (BRS) operators at 1‑844‑524‑5286.

Until your direct deposit information has been updated, you will continue to be paid by cheque. If you update your direct deposit information, do not close the old account before we deposit the payment into the new account. To update your banking information, please complete a new direct deposit enrolment form. Please do not use this form to provide change of address information.

Please read the Privacy notice.

Part A - Identification information

Surname (maximum of 20 characters) (required)

Given name (maximum of 20 characters) (required)

Initial(s) (maximum of 2 characters)

Address (maximum of 50 characters) (required)

City, Town (maximum of 20 characters) (required)

Province (required) Select AB BC MB NB NL NT NS NU ON PE QC SK YT

Postal code (no space) (required)

Telephone No. (999‑999‑9999)

Date of Birth (YYYY‑MM‑DD) (required)

Social Insurance No. (Canada Revenue Agency) (no dashes or spaces, 9 digits) (required)

Part B ‑ Payment information (Indicate the payment(s) you currently receive by cheque) (Required)

Canada Revenue Agency

Income Tax Refund, Goods and Services Tax (GST)/Harmonized Sales Tax (HST) credit, Canada Child Benefit (CCB) and any related provincial and territorial payments, Working income tax benefit (WITB) advance payments, any other deemed overpayment of tax, and any applicant benefit payments for previous years. I understand that providing new banking information replaces any banking information on file with Canada Revenue Agency (CRA) and will stay in effect until changed by me.

Canada Revenue Agency Payment(s) Yes/No Select Yes No

Service Canada

Old Age Security Yes/No Select Yes No

Canada Pension Plan Yes/No Select Yes No

Part C ‑ Banking information (Canadian financial institutions only)

IMPORTANT: Complete Part C or attach a blank cheque with "VOID" written on it.

1. Cheque No. ‑ not required.
2. Branch No. ‑ 5 digits.
3. Institution No. ‑ 3 digits.
4. Account No. ‑ as shown on your cheque.

A void cheque will be attached to the form

Branch No. (5 digits)
(required when void cheque is not attached) Institution No. (3 digits)
(required when void cheque is not attached) Account No. (dashes also accepted, 12 digits)
(required when void cheque is not attached)

Financial institution's stamp here (required when void cheque is not attached)

 

Name(s) of Account Holder(s)
(required when void cheque is not attached)
Name(s) of Account Holder(s)(continued)

Part D ‑ Consent

Provision of the personal information, including your Social Insurance Number (SIN), is pursuant to the Department of Public Works and Government Services Act, s. 5, s. 11 and the Financial Administration Act s. 35(2). The Receiver General will use and disclose information to the federal institutions identified in Part B and to your financial institution in order to issue direct deposit payments, but will not disclose your SIN to your financial institution. Your personal information will be protected, used and disclosed in accordance with the Privacy Act, and as described in Personal Information Bank PWGSC PCU 712, Receiver General Payments. Under the Act, you have the right to access and correct your personal information, if erroneous or incomplete.

I, the undersigned, have read the Privacy notice and consent to the collection, use, and disclosure of my personal information as described therein.

Date (YYYY-MM-DD)

2016-12-07

Signature of Applicant

Please do not use this form to provide change of address information.

Please ensure that you sign the form before mailing.

Please "clear data" once the form has been printed to ensure that your information is not visible to other users of this computer.

Mailing address

Mail the completed form to:

Receiver General for Canada
P.O. Box 5000
Matane, QC
G4W 4R6